Provider Demographics
NPI:1114378932
Name:PATEL, CHANDNI P (RPH)
Entity Type:Individual
Prefix:
First Name:CHANDNI
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 S VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6592
Mailing Address - Country:US
Mailing Address - Phone:805-644-1833
Mailing Address - Fax:805-644-1782
Practice Address - Street 1:1740 S VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6592
Practice Address - Country:US
Practice Address - Phone:805-644-1833
Practice Address - Fax:805-644-1782
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74450183500000X
CT0013447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist